Health inspection·February 20, 2024

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some admitted to the Nursing Facility on [DATE] and re-admitted on [DATE] with the diagnoses of dementia, displaced intertrochanteric fracture of right femur-initial encounter for a closed fracture dated [DATE] (broken right leg), traumatic subarachnoid hemorrhage without loss of consciousness dated [DATE] ( true emergencies that demand prompt treatment. Subarachnoid hemorrhages result from a medical aneurysmal rupture or traumatic head injury, resulting in bleeding in the subarachnoid space between the arachnoid membrane and the [NAME] mater surrounding the brain)., major depressive disorder dated [DATE], muscle wasting and atrophy, difficulty in walking, type 2 diabetes (high blood sugar), hyperlipidemia (high cholesterol), hypothyroidism, morbid (severe) obesity, atherosclerotic heart disease, bipolar disorder, and hypertension (high blood pressure). Record review of CR#1's Quarterly MDS dated [DATE] revealed a BIMS score of 13 indicating cognition is intact. Section on Behavior revealed none of the above. Section on Functional Abilities and goals revealed wheelchair, roll left and right, sit to lying were substantial/maximal assistance, Sit to stand and walk 10 feet were not applicable. Pain presence was occasional and pain intensity was a 7. Falls revealed injury (except major) skin tears, abrasions, lacerations, superficial bruises, hematomas and sprains, or any fall-related injury that causes the resident to complain of pain. Restraints and Alarms section revealed there was no bed rail, bed alarm, chair alarm, or floor mat alarm. Record review of CR#1's Quarterly MDS dated [DATE] did not reveal a fall mat. Record review of CR# 1's Comprehensive Care plan undated revealed: CR #1 was identified to be at risk for increased falls and fractures as evidence by: Actual fall with c/o pain to neck and head [DATE], Actual fall no injury - [DATE], Actual fall no injury - [DATE], Actual fall with hematoma to middle of forehead/ bleeding from nostrils - [DATE] Date Initiated: [DATE] Revision on: [DATE]. Interventions: Personal items to be placed within reach. Date Initiated: [DATE], Transferred to [Hospital] for further evaluation Date Initiated: [DATE], Transferred to ER for further eval [DATE] Date Initiated: [DATE]. Revision on: [DATE], Anticipate needs, provide prompt assistance. Date Initiated: [DATE], Assure lighting is adequate and areas are free of clutter. Date Initiated: [DATE], Encourage resident to ask for assistance of staff. Date Initiated: [DATE], Encourage socialization and activity attendance as tolerated. Date Initiated: [DATE], Ensure call light is in reach and answer promptly. Date Initiated: [DATE] .Focus: [CR#1] is Moderate risk for increased falls and fractures as evidence by: Gait/balance problems Date Initiated: [DATE] Revision on: [DATE] .Interventions: Anticipate and meet The resident's needs. Date Initiated: [DATE], Be sure The resident's call light is within reach and encourage the resident to use it for assistance as needed. The resident needs prompt response to all requests for assistance. Date Initiated: [DATE], Educate the resident/family/caregivers about safety reminders and what to do if a fall occurs. Date Initiated: [DATE], Follow facility fall protocol. Date Initiated: [DATE], Pt evaluate and treat as ordered or PRN. Date Initiated: [DATE] .Focus: [CR#1] has a behavior problem r/t Low frustration tolerance .Resident stated she had a fall at [local behavior facility] with pain on her right leg - [DATE] .Interventions: Send to [Local Hospital] for further evaluation Date Initiated: [DATE], Stat Xray Date Initiated: [DATE]. Focus: ADL self-care performance deficit d/t complications r/t disease processes. Date Initiated: [DATE] Revision on: [DATE]. Interventions: BATHING/SHOWERING: The resident totally Dependent by 1-2 staff with bathing/showering as necessary. Date Initiated: [DATE] Revision on: [DATE], BED MOBILITY: The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 2 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some resident requires Extensive assistance by 1-2 staff to turn and reposition in bed as necessary. Date Initiated: [DATE] Revision on: [DATE], DRESSING: The resident requires Extensive assistance by 1-2 staff to dress. Date Initiated: [DATE] Revision on: [DATE], EATING: The resident requires Supervision by 1 staff to eat. Date Initiated: [DATE] Revision on: [DATE], PERSONAL HYGIENE: The resident requires Extensive assistance by 1 staff with personal hygiene and oral care. Date Initiated: [DATE] Revision on: [DATE], TOILET USE: The resident requires Extensive Assistance by 1-2 staff for toileting. Date Initiated: [DATE] Revision on: [DATE], TRANSFER: The resident requires Mechanical Lift Hoyer lift with 2 staff assistance for transfers. Date Initiated: [DATE] Revision on: [DATE], Encourage the resident to participate to the fullest extent possible with each interaction. Date Initiated: [DATE], Encourage the resident to use bell to call for assistance. Date Initiated: [DATE], Praise all efforts at self-care. Date Initiated: [DATE], PT/OT evaluation and treatment as per MD orders. Date Initiated: [DATE]. Focus: Right Femur fracture r/t fall Date Initiated: [DATE] Revision on: [DATE]. Interventions: Anticipate and meet needs. Be sure call light is within reach and respond promptly to all requests for assistance. Date Initiated: [DATE], Follow MD orders for weight bearing status. See MD orders and/or PT treatment plan. Date Initiated: [DATE], Monitor/document pain on a scale of 0 to 10 before and after implementing measures to reduce pain. Date Initiated: [DATE], PT, OT evaluation and treatment per orders. Date Initiated: [DATE], Reposition as necessary to prevent skin breakdown. Prevent 90-degree flexion to prevent circulation problems. Date Initiated: [DATE]. Record review of CR#1's Order Summary Report dated [DATE] revealed: STAT X-RAY TO RIGHT HIP/KNEE R/T PAIN. STAT Phone ordered [DATE]. Assess if resident has shortness of breath while lying flat. every shift ordered [DATE]. Assess if resident has shortness of breath while lying flat. every shift Verbal Discontinued [DATE]. May have side rails up at HS and while in bed to enhance positioning and mobility Phone ordered [DATE]. May have side rails up at HS and while in bed to enhance positioning and mobility Phone Discontinued [DATE]. May have side rails up at HS and while in bed to enhance positioning and mobility Phone Discontinued [DATE]. May have side rails up at HS and while in bed to enhance positioning and mobility Verbal Discontinued [DATE]. Monitor for signs and symptoms of adverse reaction: interocular hemorrhage, abdominal pain, flatulence, alopecia, rash, pruritus, taste disturbance, tissue necrosis, headache, lethargy, dizziness, hematuria, anemia, hepatitis, respiratory tract bleeding, hypersensitivity reaction, hemorrhage, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 3 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some bloody dyscrasias, fever, purple toe syndrome, increased fracture risk with long term use. every shift Phone ordered [DATE]. Monitor for signs and symptoms of adverse reaction: interocular hemorrhage, abdominal pain, flatulence, alopecia, rash, pruritus, taste disturbance, tissue necrosis, headache, lethargy, dizziness, hematuria, anemia, hepatitis, respiratory tract bleeding, hypersensitivity reaction, hemorrhage, bloody dyscrasias, fever, purple toe syndrome, increased fracture risk with long term use. every shift Phone Discontinued [DATE]. monitor for signs and symptoms of adverse reaction: interocular hemorrhage, abdominal pain, flatulence, alopecia, rash, pruritus, taste disturbance, tissue necrosis, headache, lethargy, dizziness, hematuria, anemia, hepatitis, respiratory tract bleeding, hypersensitivity reaction, hemorrhage, bloody dyscrasias, fever, purple toe syndrome, increased fracture risk with long term use. every shift Verbal Discontinued [DATE]. monitor for signs and symptoms of adverse reaction: interocular hemorrhage, abdominal pain, flatulence, alopecia, rash, pruritus, taste disturbance, tissue necrosis, headache, lethargy, dizziness, hematuria, anemia, hepatitis, respiratory tract bleeding, hypersensitivity reaction, hemorrhage, bloody dyscrasias, fever, purple toe syndrome, increased fracture risk with long term use. Y/N every shift for Assessment Phone Discontinued [DATE]. MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 -medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift Phone ordered [DATE]. MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 -medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift Phone Discontinued [DATE]. MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 -medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift Verbal Discontinued [DATE]. MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 -medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift for Pain Phone Discontinued [DATE]. OT to eval and Tx as indicated Phone Discontinued [DATE]. OT to eval and Tx AS INDICATED Verbal Discontinued [DATE]. Pain Management consult Prescriber Written Discontinued [DATE]. PT clarification: Pt to be seen 3x/wk x 5 wks for therapy ex, therapy act, gait training, neuro re-ed, modalities, group and pt/caregiver training to improve functional mobility and increase functional independence. Phone Discontinued [DATE]. PT clarification: Pt to be seen 3x/wk x 6 wks for therapy ex, therapy act, gait training, neuro (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 4 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety re-ed, modalities and pt/caregiver training to improve functional mobility and independence. Phone Discontinued [DATE]. PT CLARIFICATION: Skilled Pt services for 3x/week for 30days to address m62.81, m62.59, R27.8, r26.2 with therapy ex, therapy act, neuro re-ed, group therapy. one time only for 30 Days Phone Discontinued [DATE] [DATE] [DATE]. Residents Affected - Some PT recertification: Pt to be seen 3x/wk x 6 wks for therapy ex, therapy act, gait training, neuro re-ed, modalities and pt/caregiver training to improve functional mobility and independence. Phone Active [DATE] Pt to eval and treat. one time only for 1 Day Phone Completed [DATE] [DATE] [DATE]. PT TO EVAL AND TX AS INDICATED Phone Active [DATE]. PT TO EVAL AND TX AS INDICATED Phone Discontinued [DATE]. PT TO EVAL AND TX AS INDICATED Phone Discontinued [DATE]. PT TO EVAL AND TX AS INDICATED Verbal Discontinued [DATE]. PT/OT TO EVAL AND TREAT AS INDICATED Prescriber Written Discontinued [DATE]. PT/OT/ST TO EVAL AND TREAT AS INDICATED Prescriber Written Active [DATE]. Resident transferred to [local acute hospital] r/t fall for observation. Phone Active [DATE] Send resident to methodist hospital r/t right leg pain r/o fracture per MD. Phone Discontinued [DATE]. Acetaminophen Oral Tablet 325 MG (Acetaminophen) Give 2 tablet by mouth every 4 hours as needed for Pain Phone Active [DATE]. Acetaminophen Oral Tablet 500 MG (Acetaminophen) Give 1 tablet by mouth every 6 hours as needed for mild pain. Phone Discontinued [DATE]. Advil PM Oral Capsule 200-25 MG (Ibuprofen-Diphenhydramine HCl) Give 1 capsule by mouth at bedtime for Insomnia. Phone Discontinued [DATE]. Advil PM Oral Capsule 200-25 MG (Ibuprofen-Diphenhydramine HCl) Give 1 capsule by mouth at bedtime for insomnia. Prescriber Written Discontinued [DATE]. Aspirin EC Low Strength Oral Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 5 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 a day for CAD. Level of Harm - Immediate jeopardy to resident health or safety Phone Discontinued [DATE]. Aspirin EC Low Strength Oral Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day for CAD. Residents Affected - Some Phone Discontinued [DATE]. Aspirin EC Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day for MI Do Not Crush Phone Discontinued [DATE]. Aspirin Low Dose Oral Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day for blood thinner. Verbal Discontinued [DATE]. Aspirin Low Dose Oral Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day for MI Phone Active [DATE]. Eliquis Oral Tablet 5 MG (Apixaban) Give 1 tablet by mouth two times a day for DVT prevention Phone Active [DATE]. Eliquis Oral Tablet 5 MG (Apixaban) Give 5 mg by mouth two times a day for Prophylaxis; dvt Prescriber Written Discontinued [DATE]. Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 6 hours as needed for pain mgmt. Prescriber Written Discontinued [DATE]. Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 8 hours as needed for Pain Phone Active [DATE]. Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 8 hours as needed for Pain Phone Discontinued [DATE]. Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 8 hours as needed for pain Verbal Discontinued [DATE]. Hydrocodone-Acetaminophen Tablet 5-325 MG Give 1 tablet by mouth every 6 hours as needed for pain Phone Discontinued [DATE]. Record review of CR#1's Pain Level Summary: [DATE] 3:23 a.m. level 6 [DATE] 8:45 p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 6 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 level 6 Level of Harm - Immediate jeopardy to resident health or safety [DATE] 12:21 a.m. Residents Affected - Some [DATE] 10:00 p.m. level 0 level 3 [DATE] 8:22 p.m. level 3 [DATE] 4:50 a.m. level 5 [DATE] 7:47 a.m. level 5 [DATE] 7:59 a.m. level 5 [DATE] 10:17 p.m. level 0 [DATE] 1:51 a.m. level 7 [DATE] 10:54 p.m. level 0 [DATE] nothing noted [DATE] 5:17 a.m. level 0 [DATE] 5:18 a.m. level 1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 7 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 [DATE] 8:32 a.m. Level of Harm - Immediate jeopardy to resident health or safety level 3 Residents Affected - Some level 0 [DATE] 9:18 a.m. [DATE] 1:47 p.m. level 5 Record review of CR#1's [DATE] Medication Administration Record revealed: MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 - medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift. -D/C Date- [DATE] 12:03 p.m.[DATE] at 6 p.m. to did not reveal any pain. [DATE] at 6 a.m. revealed level 5 pain Diclofenac Sodium External Gel 1 % (Diclofenac Sodium (Topical)) Apply to knee/back topically three times a day for osteoarthritis -D/C Date- [DATE] 12:03 p.m. [DATE] at 9 p.m. pain level 1 [DATE] at 9 a.m. pain level 3 [DATE] at 2 p.m. pain level 5 Hydrocodone-Acetaminophen Tablet 5-325 MG Give 1 tablet by mouth every 6 hours as needed for pain -D/C Date- [DATE] 12:03 p.m. [DATE] left blank [DATE] pain level 5 at 1:37 p.m. Tylenol Extra Strength Oral Tablet 500 MG (Acetaminophen) Give 1 tablet by mouth every 6 hours as needed for pain -D/C Date[DATE] 3:57 p.m. nothing noted. STAT X-RAY TO RIGHT HIP/KNEE R/T PAIN. STAT -Start Date- [DATE] 9:53 a.m. [DATE] not completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 8 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of CR#1's Nurse notes dated [DATE] at 2:14 p.m. written by ADON A revealed, Resident arrived via wheelchair with EMS from Behavior Hospital, AA&Ox3, respiratory even and unlabored skin warm and dry to touch, denies pain at this time, notified MD and [CR#1's family member] call light in reach will continues to monitor. Record review of CR#1's Morse Fall Scale dated [DATE] at 2:39 p.m. revealed Moderate Risk for Falling. No History of falling, no ambulatory aides are used (bedrest/wheelchair/nurse assisted), gait impaired with difficulty rising from chair, uses chair arms to get up, bounces to rise-keeps head down when walking, watches the ground- grasps furniture, person or aide when ambulating. Cannot walk unassisted. Mental Status: Overestimates or forgets limits. Record review of CR#1's Skin/Wound Note dated [DATE] at 7:47 p.m. by Wound Care Nurse revealed, Resident re-admitted to facility. Head to toe skin assessment performed. Sacrum intact. Bilateral heels noted dry & flaky. Left heel noted with peeling skin. Will continue to monitor. Record review of CR#1's Weekly Skin assessment dated [DATE] at 7:45 p.m. by Wound Care Nurse did not reveal anything about CR#1 being in pain. Record review of CR#1's Health Status Note dated [DATE] at 9:35 a.m. by ADON A revealed, While in room changing resident complained of pain to right leg stating she fell at the other place, notified MD for new orders, [CR#1's family member] is aware. Calling other facility to confirm resident had a fall. Record review of CR#1's Incident note dated [DATE] at 2:24 p.m. written by DON/DCO Note Text: ADCO stopped by resident rm to provide, resident told ADCO that her right leg hurt because I had a fall at the other place MD [CR #1's family member] notified, Pain ,eds administered pe[CR #1's family member] prn order, MD gave orders for stat x-ray, DCO called [local psychiatric center] to investigate incident of fall as stated by resident .Resident now to be transferred to [CR #1's family member] choice of hospital for further eval. National EMS called and scheduled transportation p/u, eta 1hr, [CR #1 family member] notify with p/u information. Record review of CR#1's Nurse Note dated [DATE] at 10:45 a.m. written by MDS Coordinator revealed, CR#1's family member approached writer at nurses station requesting to speak to someone regarding her mother. Writer inquired was there anything that I can assist with? [CR#1's family member] stated I need someone to arrange transportation for my mother to go to the hospital, she told me that she had a fall at [local psychiatric facility] and now her leg is hurting, she needs X-rays Informed [CR#1's family member] that we could do X-rays here at the facility, [CR #1'S FAMILY MEMBER] inquired When I can't wait all day for her X-rays? Writer informed Management staff and charge nurse of [CR#1's family member] request and was informed that a STAT X-ray of right hip/knee was ordered and requested already. Informed [CR #1'S FAMILY MEMBER] that we received an order from the DR for STAT X-rays, X-ray tech was on their way to facility to obtained X-ray's. [CR #1'S FAMILY MEMBER] stated Fine I will wait until 12pm, then she's going to the hospital. That's my mother and I have to take care of her. Writer comforted [CR #1'S FAMILY MEMBER] and voiced understanding. [CR #1'S FAMILY MEMBER] returned to resident room, to await X-ray tech. Record review of CR#1's Progress note date [DATE] at 12:19 p.m. written by Physician revealed, CR#1 readmitted from [local psychiatric facility]. [CR#1] seen/examined. Complained of right thigh area pain with rom. Stated that she fell at [local psychiatric facility] without workup. Will send to acute hospital for workup fracture versus dislocations .fall precautions, pain control (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 9 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 .concerns/questions/plan of care addressed with CR#1's family member at bedside. Level of Harm - Immediate jeopardy to resident health or safety Record review of CR#1's Local Hospital noes dated [DATE] at 12:30 p.m. revealed s/p fall Fractured right hip, right heel deep tissue injury. Arrival date [DATE] at 4:41 p.m. Arrived by ambulance. Residents Affected - Some Record review of CR#1's Nurse notes dated [DATE] at 18:02 by LVN B revealed CR#1 was Received via bed. Color is good, skin is warm/dry to touch. Resp. are easy/unlabored. Able to make her needs known staff. Requires 1:1 assist with her ADLS. No hypo/hyperglycemic reactions noted. Slight bleeding noted from her buttock during ADL care. She is constantly c/o why we don't like her and why we are out to get her, unable to re-direct @ this time, made as comfortable as possible. Was medicated with PRN Hydrocodone & Hydroxyzine. Will cont.to monitor. Record review of CR#1's screenshot of video dated [DATE] at 11:55 p.m. revealed a CNA standing by CR#1's bedside wither hands in her pocket and looking at CR#1. The CNA was observed standing away from CR#1 and CR#1 was observed lying to one side of the bed all the way to at the edge of the bed and looking at the CNA. Observation revealed CR#1 was not laying on her pillow and was laying to in the corner of the bed by the window. Record review of CR#1's screenshot of video dated [DATE] at 12:45 a.m. revealed CR#1 on the floor by her window and lying leaning on the air conditioner. Observation revealed there was no fall mat on either side of the bed. Record review of CR#1's Nurse note dated [DATE] at 12:59 by LVN A revealed, At approximately 12:50 a.m. [CR31] was observed on the floor screaming in severe pain to her head and neck. During assessment a raised area was noted on her right forehead.res stated she was trying to adjust her bedsheet. Nurse initiated 911 for further medical evaluation .V/S at this time were Bp 110/61, P 73, T 97.8, RR 20,02 SAT 97% RA.RP notified via VM , Md ,DON,ADON notified. Record review of CR#1's SBAR, Change in Condition dated [DATE] at 1:54 a.m. revealed, The Change in Condition/s reported on this CIC Evaluation are/were Falls. Resident is on anticoagulant other than warfarin. Pain Status: Yes. Record review of CR#1's Nurse note dated [DATE] at 3:17 a.m. by LVN A revealed, 911 initiated,2 technicians p/u resident via stretcher to [Local Hospital] for further medical evaluation and treatment. Record review of CR#1's Local Hospital Progress note dated [DATE] at 11:18 a.m. revealed admit date [DATE], Chief complaint: Fall on blood thinners .Subarachnoid hemorrhage after fall on blood thinners, received Kcentra in ER, neurosurgery consulted, appreciate recs, received loading dose of Keppra, rapid response was called as patient was having a seizure .Chief complaint: slip and fall out of bed .CT of the head showed age indeterminate nondisplaced bilateral nasal bone fracture and a single focus of subarachnoid hemorrhage in the right inferior frontal region. She was diagnosed with subarachnoid hemorrhage. She's wheelchair bound and needed 2 persons to assist her Right periorbital soft tissue swelling. No retrobulbar hematoma, globe injury or orbital fracture. Record review of CR#1's Nurse note dated [DATE] at 5:54 p.m. by CMA A revealed, CR#1 returned from [Local Hospital] accompanied by E.M.S Personnel. Res is returning to [facility] with DX; fall, Cerebral Hemorrhage. Res is AAOX2, Denies pain and discomfort at this time. Res is total care of ADLs, Inconsonant of B/B. VS124/74, 70, 18, 97.4. R/P, M.D notified. call light within reach will continue (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 10 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 to monitor. Level of Harm - Immediate jeopardy to resident health or safety Record review of CR#1's Bed Mobility Device assessment dated [DATE] at 10:05 a.m. description Initial revealed; Bed Mobility Device Assessment: None of the above was selected. What other alternatives have been used to assist the resident prior to the application of bed rails, grab/assist bars? Meaningful/Engaging individualized activities, frequent prompting/reminders, comfortable bed, comfortable bed environment. How have alternative interventions failed to meet the residents assessed needs? n/a. Has the Interdisciplinary Team determined the use of a bed rail, grab /assist bars to be an enabler to promote independence? Yes. How will/do the bed rails or grab/assist bat assist the resident? Turning side to side, moving up or down in the bed, holding self t one side, assist with lying to sitting, improve balance during transfer, support self during transfer, exiting the bed and entering the bed. Does the resident have a diagnosis of seizures or involuntary movements? No. Type of bed rail to be used. ½ Rail on both sides. Residents Affected - Some Record review of CR#1's Bed Mobility Device assessment dated [DATE] at 10:05 a.m. reveled that low bed, increased monitoring, soft mat on floor were not selected. Record review of CR#1's Nurse note dated [DATE] at 3:20 a.m. by LVN A revealed, At approx. 3:20 a.m., Resident was observed with an unwitnessed fall, laying faced down. Resident stated she was trying to get out of the bed to get the nurse. Nurse assessed the resident, no redness or swelling noted, resident denied head injury. V/s Bp137/66 ,P 59 ,T 97.3 ,02 sat 95% RA. Nurse and the CNA assisted the resident back to bed via Hoyer lift. Resident c/o lower backpain, Prn Hydrocodone 5-325mg PO 1 tab administered to aid back pain, MD, ADON and RP notified via VM. Will continue to monitor. Call light within reach, bed at lowest position. Record review of CR#1's February Medication Administration record revealed: MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 - medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift [DATE] at 6a.m. to pain level 5 [DATE] at 6 p.m. to pain level 0 [DATE] nothing noted. Acetaminophen Oral Tablet 325 MG (Acetaminophen) Give 2 tablet by mouth every 4 hours as needed for Pain: nothing administered. Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 8 hours as needed for Pain. [DATE] Pain level 4 at 2:00 a.m. [DATE] Pain level 3 at 10 p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 11 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 [DATE] Pain level 5 at 10:56 p.m. Level of Harm - Immediate jeopardy to resident health or safety [DATE] Pain level 6 at 12:45 a.m. Hydroxyzine Pamoate Oral Capsule 50 MG (Hydroxyzine Pamoate) Give 1 capsule by mouth every 6 hours as needed for anxiety. Residents Affected - Some [DATE] administered at 8:44 p.m. Record review of CR#1's SBAR Summary, Change in Condition Evaluation dated [DATE] at 1:30 a.m. by LVN C revealed, Nursing observations, evaluation, and recommendations are Resident had an unwitnessed fall in her room. No injuries noted. Denies pain or hitting her head. Neuros stared, bed in lowest position, call light within reach. Record review of CR#1's Incident Note dated [DATE] at 1:30 a.m. with LVN C revealed, CNA called me to the room. Resident was lying in a supine position on the floor next to her bed. Resident stated that she doesn't remember how she fell out of bed. She denies pain or hitting her head. Head to toe assessment done. Assisted CNAs with getting resident back in bed via Hoyer lift. No injury noted. Neuros started, bed in lowest position, call light within reach. Advised resident to call for assistance when she needs anything. Record review of CR#1's video dated [DATE] at 3:04 a.m. revealed CR#1 was observed in bed reaching with the paper towels in her hand towards the floor at 3:04 a.m. Bed rails were observed to be by residents head only, no bed rails observed by residents hands. Observation revealed bedside table was next to the bed. Record review of CR#1's video dated [DATE] at 3:14 a.m. revealed CNA A came into the room at 3:14 a.m. and CR#1 was observed face down on the floor next to the bed, and CNA A was observed turning off the call light, turning on the light and she stated she would get the nurse to help her with this and she said how did you do this and she asked are you okay and CR#1 said no ma'am. CR#1 was observed on the bottom bars of the bedside table face down. CNA A was observed leaving the room. Record review of CR#1's screen shot of video dated [DATE] at 3:19 a.m. revealed LVN B turned CR#1 to her side, observation revealed lots of blood on the floor. Observation revealed the bedside table had been moved away. Record review of CR#1's video dated [DATE] at 3:28 a.m. revealed LVN A in the room and CR#1 was observed being turned over onto her back, blood was observed. Resident was observed lying on her back and the nurses were attempting to get vital signs. The nurse was observed putting gloves on. Observation revealed the blood was cleaned up; they had removed CR#1's gown. CR #1 was observed laying with her head and body lying flat on the floor. Observation revealed the staff move the bed because CR#1 appeared to be very close to the bed. Observation revealed the nurses pulling CR#1 by her arm and her hip and turning her on her side and placing a Hoyer pad under her. At 3:30 a.m. the staff are observed using the Hoyer lift to attach to the Hoyer pad. They begin lifting CR#1 at 3:31 a.m. and she screamed out ouch. At 3:32 a.m.[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 12 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure each resident receives adequate supervision and assistance devices to prevent falls and major injuries causing her to be hospitalized several times with major injuries for 1 (CR#1) of ten residents reviewed for accidents, hazards, and supervision. -The facility failed to provide adequate assistive devices for CR#1 who was on anticoagulants had a history of major falls with injury on [DATE] (unwitnessed fall-fractured nose and femur), [DATE] (unwitnessed fall), [DATE] (unwitnessed fall found face down), [DATE] (unwitnessed fall cerebral hemorrhage and neck pain). -The facility failed to conduct a thorough assessment and manage pain after CR#1's fall on [DATE] and left CR#1 unattended. -The facility failed to properly support CR#1's head after her fall as her head laid flat on the floor and staff observed CR#1 gulping and swallowing blood. An Immediate Jeopardy (IJ) was identified on [DATE] at 2:52 p.m. While the IJ was lowered on [DATE] at 11:46 a.m., to no actual harm with potential for more than minimal harm that is not Immediate Jeopardy at a scope of pattern while the facility continued to monitor the implementation of effectiveness of their plan of removal. These failures could place residents at risk of harm, severe injuries, hospitalization, and death who are totally dependent on staff for Activities of daily living, supervision, bed mobility, and safety at risk for falls, not being adequately care planned to receive devices to prevent falls, not being thoroughly assessed after a fall, not being properly assessed for pain that resulted in actual harm to CR #1 causing her pain, lower quality of life, falls with fractures, hematomas and CR #1 passed away on [DATE]. Findings include: Record review of CR #1's face sheet dated [DATE] revealed a [AGE] year-old female who initially admitted to the Nursing Facility on [DATE] and re-admitted on [DATE] with the diagnoses of displaced intertrochanteric fracture of right femur-initial encounter for a closed fracture dated [DATE] (broken right leg), traumatic subarachnoid hemorrhage without loss of consciousness dated [DATE] ( true emergencies that demand prompt treatment. Subarachnoid hemorrhages result from a medical aneurysmal rupture or traumatic head injury, resulting in bleeding in the subarachnoid space between the arachnoid membrane and the [NAME] mater surrounding the brain)., muscle wasting and atrophy, difficulty in walking, and morbid (severe) obesity (over weight). Record review of CR#1's Quarterly MDS dated [DATE] revealed a BIMS score of 13 indicating the residents cognition was intact. The resident did not have behavior problems noted. The resident used a wheelchair for mobility. She required substantial/maximal assistance with rolling left and right and moving from a sit to lying down position. The resident had occasional pain with an intensity level of 7. RCR #1 had falls that resulted in injury (except major) such as: skin tears, abrasions, lacerations, superficial bruises, hematomas and sprains, or any fall-related injury that causes the resident to complain of pain. CR #1did not have bed rail, bed alarm, chair alarm, or floor mat alarm. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 13 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 MDS did not address a fall mat being used. Level of Harm - Immediate jeopardy to resident health or safety Record review of CR# 1's Comprehensive Care plan undated revealed the following care areas: Residents Affected - Some Actual fall with c/o pain to neck and head -[DATE], *Falls, the resident was at risk for increased falls and fractures as evidence by: Actual fall no injury - [DATE], Actual fall no injury - [DATE], Actual fall with hematoma to middle of forehead/ bleeding from nostrils - [DATE] Date Initiated: [DATE] Revision on: [DATE]. The interventions included for Personal items to be placed within reach. Date Initiated: [DATE], Transferred to [Hospital] for further evaluation Date Initiated: [DATE], Transferred to ER for further eval [DATE] Date Initiated: [DATE] Revision on: [DATE], Anticipate needs, provide prompt assistance. Date Initiated: [DATE], Assure lighting is adequate and areas are free of clutter. Date Initiated: [DATE], Encourage resident to ask for assistance of staff. Date Initiated: [DATE], Encourage socialization and activity attendance as tolerated. Date Initiated: [DATE], Ensure call light is in reach and answer promptly. * CR#1 was Moderate risk for increased falls and fractures as evidence by: Gait/balance problems Date Initiated: [DATE] Revision on: [DATE] . The Interventions included to Anticipate and meet The resident's needs, Be sure The resident's call light is within reach and encourage the resident to use it for assistance as needed. The resident needs prompt response to all requests for assistance, Educate the resident/family/caregivers about safety reminders and what to do if a fall occurs, Follow facility fall protocol, Pt evaluate and treat as ordered or PRN. * CR#1 had a behavior problem r/t Low frustration tolerance .Resident stated she had a fall at [local behavior facility] with pain on her right leg Date Initiated: [DATE] . The interventions were to send to [Local Hospital] for further evaluation and Stat Xray. * ADL self-care performance deficit d/t complications r/t disease processes. Date Initiated: [DATE] Revision on: [DATE]. The interventions indicated the resident was totally Dependent by 1-2 staff with bathing and showering. Required extensive assistance by 1-2 staff to turn and reposition in bed, personal hygiene and oral care, toileting, and dressing. The resident required Supervision by 1 staff to eat. The resident required Mechanical Lift Hoyer lift with 2 staff assistance for transfers. Additional interventions were to Encourage the resident to participate to the fullest extent possible with each interaction. use bell to call for assistance. Praise all efforts at self-care., PT/OT evaluation and treatment as per MD orders. * Right Femur fracture r/t fall Date Initiated: [DATE] Revision on: [DATE]. The interventions (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 14 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety included to anticipate and meet needs, be sure call light was within reach and respond promptly to all requests for assistance, follow MD orders for weight bearing status, see MD orders and/or PT treatment plan, Monitor/document pain on a scale of 0 to 10 before and after implementing measures to reduce pain, PT/ OT evaluation and treatment per orders, Reposition as necessary to prevent skin breakdown, and to prevent 90-degree flexion to prevent circulation problems. Residents Affected - Some Record review of CR#1's Order Summary Report dated [DATE] revealed: *STAT X-RAY TO RIGHT HIP/KNEE R/T PAIN. STAT Phone ordered [DATE] *Assess if resident has shortness of breath while lying flat. every shift ordered [DATE] *Assess if resident has shortness of breath while lying flat. every shift Verbal Discontinued [DATE] 0*May have side rails up at HS and while in bed to enhance positioning and mobility Phone ordered [DATE] *May have side rails up at HS and while in bed to enhance positioning and mobility Phone Discontinued [DATE] *May have side rails up at HS and while in bed to enhance positioning and mobility Phone Discontinued [DATE] *May have side rails up at HS and while in bed to enhance positioning and mobility Verbal Discontinued [DATE] *Monitor for signs and symptoms of adverse reaction: interocular hemorrhage, abdominal pain, flatulence, alopecia, rash, pruritus, taste disturbance, tissue necrosis, headache, lethargy, dizziness, hematuria, anemia, hepatitis, respiratory tract bleeding, hypersensitivity reaction, hemorrhage, bloody dyscrasias, fever, purple toe syndrome, increased fracture risk with long term use. every shift Phone ordered [DATE] *Monitor for signs and symptoms of adverse reaction: interocular hemorrhage, abdominal pain, flatulence, alopecia, rash, pruritus, taste disturbance, tissue necrosis, headache, lethargy, dizziness, hematuria, anemia, hepatitis, respiratory tract bleeding, hypersensitivity reaction, hemorrhage, bloody dyscrasias, fever, purple toe syndrome, increased fracture risk with long term use. every shift Phone Discontinued [DATE] *monitor for signs and symptoms of adverse reaction: interocular hemorrhage, abdominal pain, flatulence, alopecia, rash, pruritus, taste disturbance, tissue necrosis, headache, lethargy, dizziness, hematuria, anemia, hepatitis, respiratory tract bleeding, hypersensitivity reaction, hemorrhage, bloody dyscrasias, fever, purple toe syndrome, increased fracture risk with long term use. every shift Verbal Discontinued [DATE] *monitor for signs and symptoms of adverse reaction: interocular hemorrhage, abdominal pain, flatulence, alopecia, rash, pruritus, taste disturbance, tissue necrosis, headache, lethargy, dizziness, hematuria, anemia, hepatitis, respiratory tract bleeding, hypersensitivity reaction, hemorrhage, bloody dyscrasias, fever, purple toe syndrome, increased fracture risk with long term use. Y/N every (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 15 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 shift for Assessment Phone Discontinued [DATE] Level of Harm - Immediate jeopardy to resident health or safety *MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 -medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift Phone ordered [DATE] Residents Affected - Some *MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 -medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift Phone Discontinued [DATE] *MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes: 0 - none, 1 -medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift Verbal Discontinued [DATE] *PT TO EVAL AND TX AS INDICATED Phone Discontinued [DATE] *PT TO EVAL AND TX AS INDICATED Verbal Discontinued [DATE] *Resident transferred to [local hospital] r/t fall for observation. Phone Active [DATE] *Send resident to [local] hospital r/t right leg pain r/o fracture per MD. Phone Discontinued [DATE] *Acetaminophen Oral Tablet 325 MG (Acetaminophen) Give 2 tablet by mouth every 4 hours as needed for Pain Phone Active [DATE] *Acetaminophen Oral Tablet 500 MG (Acetaminophen) Give 1 tablet by mouth every 6 hours as needed for mild pain Phone Discontinued [DATE] *Advil PM Oral Capsule 200-25 MG (Ibuprofen-Diphenhydramine HCl) Give 1 capsule by mouth at bedtime for Insomnia Phone Discontinued [DATE] *Advil PM Oral Capsule 200-25 MG (Ibuprofen-Diphenhydramine HCl) Give 1 capsule by mouth at bedtime for insomnia Prescriber Written Discontinued [DATE] *Aspirin EC Low Strength Oral Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day for CAD Phone Discontinued [DATE] *Aspirin EC Low Strength Oral Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day for CAD (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 16 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Phone Discontinued [DATE] Level of Harm - Immediate jeopardy to resident health or safety *Aspirin EC Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day for MI Do Not Crush Phone Discontinued [DATE] Residents Affected - Some *Aspirin Low Dose Oral Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day for blood thinner Verbal Discontinued [DATE] *Aspirin Low Dose Oral Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day for MI Phone Active [DATE] *Eliquis Oral Tablet 5 MG (Apixaban) Give 1 tablet by mouth two times a day for DVT prevention Phone Active [DATE] *Eliquis Oral Tablet 5 MG (Apixaban) Give 5 mg by mouth two times a day for Prophylaxis; dvt Prescriber Written Discontinued [DATE] *Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 6 hours as needed for pain mgmt. Prescriber Written Discontinued [DATE] *Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 8 hours as needed for Pain Phone Active [DATE] *Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 8 hours as needed for Pain Phone Discontinued [DATE] *Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 8 hours as needed for pain Verbal Discontinued [DATE] *Hydrocodone-Acetaminophen Tablet 5-325 MG Give 1 tablet by mouth every 6 hours as needed for pain Phone Discontinued [DATE] Record review of CR#1's Pain Level Summary dated [DATE]: [DATE] 3:23 a.m. level 6 [DATE] 8:45 p.m. level 6 [DATE] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 17 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 12:21 a.m. Level of Harm - Immediate jeopardy to resident health or safety level 0 Residents Affected - Some 10:00 p.m. [DATE] level 3 [DATE] 8:22 p.m. level 3 [DATE] 4:50 a.m. level 5 [DATE] 7:47 a.m. level 5 [DATE] 7:59 a.m. level 5 [DATE] 10:17 p.m. level 0 [DATE] 1:51 a.m. level 7 [DATE] 10:54 p.m. level 0 [DATE] nothing noted (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 18 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 [DATE] Level of Harm - Immediate jeopardy to resident health or safety 5:17 a.m. Residents Affected - Some [DATE] level 0 5:18 a.m. level 1 [DATE] 8:32 a.m. level 3 [DATE] 9:18 a.m. level 0 [DATE] 1:47 p.m. level 5 Record review of CR#1's Nurse notes dated [DATE] at 2:14 p.m. written by ADON A revealed, Resident arrived via wheelchair with EMS from Behavior Hospital, Alert and orientedx3, respiratory even and unlabored skin warm and dry to touch, denies pain at this time, notified MD and [CR#1's family member] call light in reach will continues to monitor. Record review of CR#1's Health Status Note dated [DATE] at 9:35 a.m. by ADON A revealed, While in room changing resident complained of pain to right leg stating she fell at the other place, notified MD for new orders, [CR#1's family member] was aware. Calling other facility to confirm resident had a fall. Record review of CR#1's Incident note dated [DATE] at 2:24 p.m. written by DON/DCO revealed, the ADCO stopped by resident rm to provide, resident told ADCO that her right leg hurt because I had a fall at the other place MD [CR #1's family member] notified, Pain, meds administered per [CR #1's family member] prn order, MD gave orders for stat x-ray, DCO called [Behavior Hospital] to investigate incident of fall as stated by resident .Resident now to be transferred to [CR #1's family member] choice of hospital for further eval. EMS called and scheduled transportation p/u, eta 1hr, [CR #1 family member] notify with p/u information. Record review of CR#1's Progress note date [DATE] at 12:19 p.m. written by Physician revealed, CR#1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 19 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some readmitted from [Behavior Hospital]. [CR#1] seen/examined. Complained of right thigh area pain with rom. Stated that she fell at [Behavior Hospital] without workup. Will send to acute hospital for workup fracture versus dislocations .fall precautions, pain control . concerns/questions/plan of care addressed with CR#1's family member at bedside. Record review of CR#1's Local Hospital noes dated [DATE] at 12:30 p.m. revealed s/p fall Fractured right hip, right heel deep tissue injury. Arrival date [DATE] at 4:41 p.m. Arrived by ambulance. Record review of CR#1's screenshot of video dated [DATE] at 11:55 p.m. revealed a CNA standing by CR#1's bedside with her hands in her pocket and looking at CR#1. The CNA was observed standing away from CR#1 and CR#1 was observed laying to one side of the bed all the way to at the edge of the bed and looking at the CNA. Observation revealed CR#1 was not laying on her pillow and was laying to in the corner of the bed by the window. Observation of video did not reveal a fall mat in the room. Record review of CR#1's screenshot of video dated [DATE] at 12:45 a.m. revealed CR#1 on the floor by her window and lying leaning on the air conditioner. Observation revealed there was no fall mat on either side of the bed. Record review of CR#1's Nurse note dated [DATE] at 12:59 by LVN A revealed, At approximately 12:50 a.m. [CR#1] was observed on the floor screaming in severe pain to her head and neck. During assessment a raised area was noted on her right forehead. [CR#1] stated she was trying to adjust her bedsheet. Nurse initiated 911 for further medical evaluation .V/S at this time were Bp 110/61, P 73, T 97.8, RR 20,02 SAT 97% RA.RP notified via VM, Md, DON, ADON notified. Record review of CR#1's SBAR, Change in Condition dated [DATE] at 1:54 a.m. revealed, The Change in Condition/s reported on this CIC Evaluation are/were: Falls. Resident is on anticoagulant other than warfarin. Pain Status: Yes. Record review of CR#1's Nurse note dated [DATE] at 3:17 a.m. by LVN A revealed, 911 initiated,2 technicians p/u resident via stretcher to [Local Hospital] for further medical evaluation and treatment. Record review of CR#1's Local Hospital Progress note dated [DATE] at 11:18 a.m. revealed admit date [DATE], Chief complaint: Fall on blood thinners .Subarachnoid hemorrhage after fall on blood thinners, received Kcentra in ER, neurosurgery consulted, appreciate recs, received loading dose of Keppra, rapid response was called as patient was having a seizure .Chief complaint: slip and fall out of bed .CT of the head showed age indeterminate nondisplaced bilateral nasal bone fracture and a single focus of subarachnoid hemorrhage in the right inferior frontal region. She was diagnosed with subarachnoid hemorrhage. She's wheelchair bound and needed 2 person to assist her Right periorbital soft tissue swelling. No retrobulbar hematoma, globe injury or orbital fracture. Record review of CR#1's Nurse note dated [DATE] at 5:54 p.m. by CMA A revealed, CR#1 returned from [Local Hospital] accompanied by E.M.S Personnel. Res is returning to [facility] with DX; fall, Cerebral Hemorrhage. Res is AAOX2, Denies pain and discomfort at this time. Res is total care of ADLs, Inconsonant of B/B. VS124/74, 70, 18, 97.4. R/P, M.D notified. call light within reach will continue to monitor. Record review of CR#1's Bed Mobility Device assessment dated [DATE] at 10:05 a.m. description Initial revealed; Bed Mobility Device Assessment: None of the above was selected. What other alternatives (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 20 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some have been used to assist the resident prior to the application of bed rails, grab/assist bars? Meaningful/Engaging individualized activities, frequent prompting/reminders, comfortable bed, comfortable bed environment. How have alternative interventions failed to meet the residents assessed needs? n/a. Has the Interdisciplinary Team determined the use of a bed rail, grab /assist bars to be an enabler to promote independence? Yes. How will/do the bed rails or grab/assist bat assist the resident? Turning side to side, moving up or down in the bed, holding self to one side, assist with laying to sitting, improve balance during transfer, support self during transfer, exiting the bed and entering the bed. Does the resident have a diagnosis of seizures or involuntary movements? No. Type of bed rail to be used. ½ Rail on both sides. Record review of CR#1's Bed Mobility Device assessment dated [DATE] at 10:05 a.m. reveled that low bed, increased monitoring, soft mat on floor were not selected. Record review of CR#1's Nurse note dated [DATE] at 3:20 a.m. by LVN A revealed, At approximately 3:20 a.m., Resident was observed with an unwitnessed fall, laying faced down. Resident stated she was trying to get out of the bed to get the nurse. Nurse assessed the resident, no redness or swelling noted, resident denied head injury. V/s Bp137/66 ,P 59 ,T 97.3 ,02 sat 95% RA. Nurse and the CNA assisted the resident back to bed via Hoyer lift. Resident c/o lower backpain, Prn Hydrocodone 5-325mg PO 1 tab administered to aid back pain, MD, ADON and RP notified via VM. Will continue to monitor. Call light within reach, bed at lowest position. Record review of CR#1's February Medication Administration record revealed: MONITORING OF PAIN -if pain is noted, chart in nurses notes the interventions/treatments used and the effectiveness - Intervention Codes:0 - none, 1 - medication, 2 - re-position, 3 - heat, 4 - cold, 5 - gentle range of motion, 6 - other (see nurses note) every shift. *[DATE] at 6a.m. to pain level 5 *[DATE] at 6 p.m. to pain level 0 *[DATE] nothing noted Acetaminophen Oral Tablet 325 MG (Acetaminophen) Give 2 tablet by mouth every 4 hours as needed for Pain: nothing administered Hydrocodone-Acetaminophen Oral Tablet 5-325 MG (Hydrocodone-Acetaminophen) Give 1 tablet by mouth every 8 hours as needed for Pain *[DATE] Pain level 4 at 2:00 a.m. *[DATE] Pain level 3 at 10 p.m. *[DATE] Pain level 5 at 10:56 p.m. *[DATE] Pain level 6 at 12:45 a.m. Hydroxyzine Pamoate Oral Capsule 50 MG (Hydroxyzine Pamoate) Give 1 capsule by mouth every 6 hours as needed for anxiety (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 21 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 *[DATE] administered at 8:44 p.m. Level of Harm - Immediate jeopardy to resident health or safety Record review of CR#1's SBAR Summary, Change in Condition Evaluation dated [DATE] at 1:30 a.m. by LVN C revealed, Nursing observations, evaluation, and recommendations are: Resident had an unwitnessed fall in her room. No injuries noted. Denies pain or hitting her head. Neuros stared, bed in lowest position, call light within reach. Residents Affected - Some Record review of CR#1's Incident Note dated [DATE] at 1:30 a.m. with LVN C revealed, CNA called me to the room. Resident was lying in a supine position on the floor next to her bed. Resident stated that she doesn't remember how she fell out of bed. She denies pain or hitting her head. Head to toe assessment done. Assisted CNAs with getting resident back in bed via Hoyer lift. No injury noted. Neuros started, bed in lowest position, call light within reach. Advised resident to call for assistance when she needs anything. Record review of CR#1's video dated [DATE] at 3:04 a.m. revealed CR#1 was observed in bed reaching with the paper towels in her hand towards the floor at 3:04 a.m. Bed rails were observed to be by residents head only, no bed rails observed by residents hands. Observation revealed bedside table was next to the bed. Observation revealed there was no fall mat in CR#1's room. Record review of CR#1's video dated [DATE] at 3:14 a.m. revealed CNA A came into the room at 3:14 a.m. and CR#1 was observed face down on the floor next to the bed, and CNA A was observed turning off the call light, turning on the light and she stated she would get the nurse to help her with this and she said how did you do this and she asked are you okay and CR#1 said no ma'am. CR#1 was observed on the bottom bars of the bedside table face down. CNA A was observed leaving the room. Record review of CR#1's screen shot of video dated [DATE] at 3:19 a.m. revealed LVN B turned CR#1 to her side, observation revealed lots of blood on the floor. Observation revealed the bedside table had been moved away. Record review of CR#1's video dated [DATE] at 3:28 a.m. revealed LVN A in the room and CR#1 was observed being turned over onto her back, blood was observed. Resident was observed lying on her back and the nurses were attempting to get vital signs. The nurse was observed putting gloves on. Observation revealed the blood was cleaned up, they had removed CR#1's gown. CR #1 was observed laying with her head and body laying flat on the floor. Observation revealed the staff move the bed because CR#1 appeared to be very close to the bed. Observation revealed the nurses pulling CR#1 by her arm and her hip and turning her on her side and placing a Hoyer pad under her. At 3:30 a.m. the staff are observed using the Hoyer lift to attach to the Hoyer pad. They begin lifting CR#1 at 3:31 a.m. and she screamed out ouch. At 3:32 a.m. the nurses were observed to continue the process of lifting CR#1 until she was placed into the bed. There was no observation of Nurses checking to see if anything was broken. Record review of CR#1's SBAR Summary: Change in Condition reported: Falls dated [DATE] at 3:40 a.m. by LVN A and LVN B revealed, Resident is on anticoagulant other than warfarin, Nursing observations, evaluation, and recommendations are: Resident had an unwitnessed fall in her room. Hematoma noted on middle forehead, bleeding from the nostrils noted. Resident continue to nod at every question asked. Record review of CR#1's Nurse Note dated [DATE] at 4:00 a.m. with LVN A revealed, At approximately 3:20 a.m. Resident had an unwitnessed fall, Nurse was notified that [CR#1] was observed on the floor (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 22 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some faced down. A large, noticeable hematoma observed on the middle of the forehead ,bleeding noted from the nostrils following the fall. Assisted resident to a seated position and assessed for injuries, Applied gentle pressure to the nose to control bleeding. Elevated the resident's head to minimize swelling and facilitate breathing, vital signs V/s Bp 138/78,P 68,RR 19,Temp 98.5,02 97%RA. 911 initiated,2 EMTs picked resident up to [local ] Hospital for further treatment. Notified MD, DON, ADON. Record review of CR#1's nurses Note dated [DATE] at 4:28 p.m. by ADON B revealed, CR#1's family member reached out to facility stating [CR#1] expired in the ICU after having 5 seizures. DCO/administrator reached out to facility to extend condolences. In an interview on [DATE] at 11:46 a.m. with CR#1's family member she stated CR#1 fell from her bed on Wednesday, [DATE] at 3 a.m. and CR#1 passed away the following day at about 4 a.m. She stated right now she was not being given CR#1's body because her death was under investigation. She stated when CR#1 was in the hospital they noticed CR#1's fall was really bad. CR#1's family member stated she pleaded with the facility to put alarms on CR#1's bed or full bed rails. She stated CR#1 fell in [DATE] and they sent her to the hospital and CR#1 had a small bleeding of the brain, so it healed on its own. She stated on [DATE], CR#1 fell at 3 a.m. and she has video footage for when they found CR#1. She stated CR#1 had an emergency seizure and she had not had a seizure in 4 years. She stated the hospital rushed CR#1 in the room and they were getting the medication for seizures and CR#1 had another seizure. CR#1's family member stated CR#1 lost a lot of blood through the nose bleed and there was a lot of blood behind her head. She stated CR#1 passed away and the hospital did CPR and brought CR#1 back, but she went for 40 minutes without getting oxygen and they would do a cat scan. CR#1's family member sated they brought CR#1 to ICU and CR#1's heart stopped beating. CR#1's family member stated CR#1 would call out to the facility staff and sometimes they came and sometimes they did not. She stated CR#1 did not have a fall mat in the room and she told the facility about it, putting the bed all the way down and not having the bed so high. She stated CR#1's fall could have been avoided and the facility should have taken other measures. She stated she was sure the facility had fall mats in the building, but she just lost CR#1. CR#1's family member stated she went to see CR#1 every morning to spend time with and CR#1 will be missed. CR#1's family member stated she thought that the facility neglected CR#1 because they have never given her a fall mat and they knew CR#1 had falls. She stated on [DATE] CR#1 had a fall and she was very messed up from her face and this fall was worse and they did not save CR#1. She stated CR#1 had a fall at [local behavioral hospital] and they brushed it under the rug. She stated it had been 10 days and CR#1 screamed when she returned to the facility and said Meha my leg is broken. She stated she asked the DON why was CR#1 screaming her leg was broken and she said she did not know. She stated the DON said she did not know and they started calling [local behavioral hospital] and they did not answer the phone. CR#1's family member stated nobody ever came to do x-rays for CR#1 and there was no concern. She stated 4 p.m. came back to the facility from the local behavioral health and the facility had not done anything. She stated at 4 p.m. CR#1 was so sedated that she did not complain from 4 p.m. that day until the next day at 8:30 a.m., she was not making noise, not asking for assistance, and no one checked on her. CR#1's family member stated when she came from the local behavioral hospital no one changed her pamper, she was so sedated, they did not know what was going on. CR#1's family member stated the local behavioral hospital had put CR#1 so much sedation and no one was concerned. She said she was not sure if CR#1 told the facility that her leg was broken until the following day when she went to see CR#1 and she told her that her leg was broken. She stated the facility did not pay attention to CR#1 when she came back from [local behavioral hospital]. In an interview and Record review of CR#1's Care Plan and Clinical records on [DATE] at 1:33 p.m. with the DON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676050 If continuation sheet Page 23 of 24 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Pasadena 3434 Watters Rd Pasadena, TX 77504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete she stated CR#1 had a fall on [DATE] and she was called by LVN A the night nurse saying CR#1 had a fall and bleeding form her nose and the middle of her head. She stated LVN A just called 911 and she said she wanted to let her know. She stated LVN A went to finish paperwork and she called the DON back. The DON stated LVN A said she went into the room and CR#1 was face down, they called CR#1's family member and the family member said she saw CR#1 on the camera attempting to pick up a paper towel. She stated LVN A said she checked CR#1's neuro's to make sure she was still breathing before they took her to the hospital. The DON stated CR#1 had a fall mat and that maybe the staff took it out to clean. The DON reviewed the care plan for a fall mat stated there was no fall mat found on the care plan. The DON stated CR#1's fall on [DATE] CR#1 was trying to get her lipstick bag and that's how she ended up on the floor. The DON stated it was in the night time and even when CR#1 was on the floor she was still applying lipstick. The DON stated CR#1 did not hit her head, but she complained that she was in pain. She stated there was no injury, but they did send her out to the local hospital. The DON stated on the day CR#1 came back from [local behavioral hospital] they were trying to put CR#1 in the chair and CR#1 screamed saying that she broke her hip. The DON stated the staff were trying to change her and put her in the wheelchair. She stated the nurse at [the local behavioral hospital] never reported it to their facility so they did not know until they called them. She stated the local behavioral hospital nurse [NAME][TRUNCATED] Event ID: Facility ID: 676050 If continuation sheet Page 24 of 24